Any use, distribution, reproduction or abstract of this publication in any medium, with the exception of commercial purposes, is permitted provided the original work is properly cited
This is an open-access article distributed under the terms of the
Creative Commons Attribution License, which permits unrestricted use,
distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

The Islamic Republic of Iran has experienced a dramatic decrease in fertility rates in the past three decades. One of the main issues in the field of fertility is the
couple’s preferences and the desire to bear children. This study aimed to determine desired number of children, fertility preference, and related factors among people referring
pre-marriage counseling to clarify their presumed behavior in case of fertility.

Materials and Methods

This study was a descriptive analytic cross-sectional survey,
conducted during 8 months. The participants were 300 couples came to pre-marriage
counseling centers of two health centers of Karaj and asked to complete a 22 items questionnaire about of demographic characteristics, participants’ interest, preference about
fertility, and economic situation.

Results

Majority of the males were between the ages of 20-30 years (66.6%) while
majority of the females were below 25 years of age (57%). About 17 percent of men and
22.3 percent of women stated that they want to have 1 child and equally 52.7 percent of
men and 52.7 percent of women wanted to have 2 children. The only factor that contributed to the female participant’s decision for a desirable number of children was the number of siblings that they have. In male participants with an increasing age at marriage and
aspiration for higher educational level, the time interval between marriage and the birth
of the first child has increased. There was a convergence in desired number of children in
male and female participants.

Conclusion

Majority of the participants express their desire to have only one or two
children in future but in considering the fact that what one desires does not always come
into reality, the risk of reduced fertility is generally present in the community. Appropriate
policies should be implemented in order to create a favorable environment for children.

Introduction

Changes in fertility rates are seen throughout the
world. The Islamic Republic of Iran has experienced
a dramatic decrease in fertility rates in the
past three decades. Population studies showed that
total fertility rate (TFR) has decreased from 7.7 in
1966 to 6.3 in 1976. Years after the Islamic Revolution,
there was a slight increase in fertility rate to
about 7 in 1980 but with initiation of the country’s
national family planning program, this figure has
declined to 5.5 (1). The fertility rate in the Islamic
Republic of Iran fell dramatically from around 7.0
births per woman in the early 1980s to 1.9 births
per woman in 2006. The total fertility rate was below
replacement level from 2006 onwards. Based
on the report given by the world bank, Iran’s population
growth rate will be below 1% by 2025 (2).

Also based on the 2006 census, the National Statistical
Center of Iran has reported a TFR of 1.9.
Postponing of childbearing is one of the reasons
of fertility decline (3). Also childbearing has been
postponed due to several reasons; advanced maternal
age at marriage, higher education and the aim
to secure economic stability before conception (4).
In Iran, fertility rate is influenced by factors such
as education, number of children, age of partner
and age at first marriage while age and income are
not considered important factors (5). It is the fact
that, the preference of family size and women’s
social background has great relevance. A study
conducted in China showed that factors contributing
in family’s preference for smaller family size
include; young age, preference to reside in the city,
and pursue higher education (6). Lower education
was associated with more number of children.

In Japan, younger women desire to have fewer
children while women in rural areas prefer to have
more numbers of children than those residing in
urban areas. The mean desired number of children
was 2.55 which were significantly more than the
mean actual number of children 1.77 in all generations
(7). One of the most important issues in relation
to fertility is the age of mother at the time of
attempting conception. Results for study conducted
in the United States of America to assess the attitudes
and awareness of male and female students
regarding conception, indicated that although 90%
of these students showed desire to have children
and highly valued parenting as an important part
of their future; lack of understanding between age
related fertility decline and the complications associated
with higher maternal age and delayed
conception proved to be extensively high (3). Due
to Iran’s declining population, the government and
policymakers have expressed great concern regarding
the sharp decline and the negative growth
in the next 40 years. Accordingly, policies on
population control that have been implemented in
Iran for 25 years have been abandoned and those
policies encouraging birth in the country’s 6th development
program are very much emphasized. It
seems that socio-economic changes that have been
shaped in Iran’s society would make it difficult to
reverse the trend of the country’s fertility rate. Delayed
fertility is related to factors including; economic,
social, and cultural which can be affected
by the couple’s intention for childbearing and their
concept of a desired family size. Education, access
to health care services, awareness, and authority to
decide on the number of children have important
role in fertility preferences (4, 8-10). Evidences
suggest that in many parts of the world, fundamental
change has taken place in an individual’s
attitude towards marriage and childbearing (2).

One of the main issues in the field of fertility and
in assessing the factors related to fertility behavior
is the couple’s preferences-fertility and the desire to
bearing child. Aside from this, the number of desired
children is considered a very important and serious
issue in predicting the actual number of children that
couple would desire as emphasized by various studies
conducted by Habbema et al. (11), and Günther
and Harttgen (12). After three years of policymaking
on the population of Iran, few studies have been conducted
specially on childbearing trends. This study
aimed to determine desired number of children, fertility
preference, and related factors among people
refer to pre-marriage counseling to clarify their presumed
behavior in case of fertility.

Materials and Methods

The present descriptive analytic cross sectional
study was conducted in the Province of Alborz, located
in the neighboring capital of Iran (with a distance
of 45 km) having an area of 5121 square kilometers
and a population of about 3 million, between
May 2014 and March 2015. This province, due to
its nearness to Tehran is the reason behind the number
of migration taking place in different parts of the country and due to the diversity of ethnicity has
been coined a name “small Iran”. The study populations
were women and men who planned to marry
in near future. The mentioned couples referred to the
pre-marriage counseling centers of Alborz province.
These centers are two university pre-marriage counseling
centers that one of them is referral.

This paper was a part of the larger study with 60
variables (items) and we have selected 10 samples
for each variable. As a result, 600 women and men
were recruited. Based on convenience sampling
method, during 8 months all the women and men
who came to two pre-marriage counseling centers
including 300 couples (600 individual) aged
between 15 to 45 years participated in this study
and were asked to complete a questionnaire. Exclusion
criteria were lack of consent to participate
in the study or any other nationality except being
Iranian. A written informed consent was obtained
from each participant after explaining the aims of
the study. None of the participants were excluded.
The self-administered anonymous questionnaire
was included 13 items; 7 items about demographic
characteristics, 6 items related to participants’ interest
and preference related to fertility. The questionnaire
included variables such as: age, education,
occupation, condition of house, predicted status of
future residence, monthly family income, number
of brother (s) or sister (s), desired number of children,
number of children based on the child’s gender,
suitable years of interval for conception of the
first baby after marriage, suitable age of marriage
for females, suitable age of marriage for males, level
of interest to become a father/mother and suitable
years of interval between pregnancies.

This questionnaire was designed and implemented
by the Ministry of Health and Medical Education,
Tehran throughout the country in order to assess
the decision making patterns of childbearing intentions.
Validity and reliability of the questionnaire was
evaluated. Content validity was analyzed by experts
in the field of fertility and demographics and minor
corrections implemented. Reliability of the questionnaire
was determined as 0.88. Statistical analysis was
done using SPSS software version 19. Also descriptive
and analytical statistics were implemented to
data analysis. This study was a small part of a larger
study designed by MOH of Iran. Ethic Committee of
Alborz University of Medical Sciences approved the
study (ABZUMS.Rec.1393.45).

Results

The age range of male participants was between
19-54 years (mean ± SD: 28.36 ± 5.8)
while the in female participants was between
13-45 years (mean ± SD: 24.8 ± 5.9). Majority
of the males were between the 20-30 years of
age (66.6%) while females were below 25 years
of age (57%). A higher percentage of men than
women had education level less than diploma. A
large percentage of men (87%) were employed,
while only 35% of women employed. Both, men
and women thought that they are going to live in
a rental house. About half of the male participants
and 37.3% of females earned less than 10 million
Rials (280 US $) respectively. The vast majority
of the participants were anticipated that they
will live in a house with size of 50 to 100 square
meters. More than 70% of samples had 1 to 4 siblings
(Table 1,).

In item of the participants’ desire to be parent,
more than 80% of men and 70% of women stated
that they are interested much and/or very much
to be parent. Less than 2 percent of both genders
were not interested to be parent. The male participants
believe that appropriate age for marriage is
26.3 for men and 21.6 for women and the female
participants mention 27.2 and 22.9 respectively for
men and women. Appropriate time for attempting
the first conception after marriage was 2.7 years
from opinions of men and women. About 17 percent
of men and 22.3 percent of women stated that
they want to have 1 child and equally 52.7 percent
of men and women wanted to have 2 children. The
only factor that contributed to the female participant’s
decision for a desirable number of children
was the number of siblings that they have. There
was a convergence in desired number of children
in male and female participants. About 10% of
men and 11% of women want to have 2 children
no difference in gender. Three percent of men and
none of the women have decided to have no child.
Demographic characteristics and desired number
of children according to gender were analyzed. Bivariate
test showed that there was significant difference
between numbers of women’s sibling and
desired numbers of children (P<0.001). Other demographic
characteristics were not related to desired
numbers of children. With the increase in the
number of siblings, desired numbers of children
was increased.

Table 2, shows demographic characteristic
and the first birth interval according to gender.
There was a statistically significant relationship
between the age of marriage and the first birth
interval (P<0.001). Also education (P<0.001)
and numbers of siblings of the participants
(P=0.007) were related to the first birth interval.
With the increase in marriage age and education
level, the first birth interval was increased, but
having more siblings led to decrease in the first
birth interval marriage age, education, income
and numbers of women’s siblings were related
to proper age for male marriage (Table 3,). These
relationships were positive for all mentioned
variables. The same variables were related to
proper age of male marriage that had relationship
to proper age of female marriage (Table 4,).
There was a statistically significant relationship
between income (P=0.01), house size of male
participants (P=0.01) and pregnancy intervals
(Table 5,). Increasing the number of siblings was
associated with pregnancy intervals inversely
(P<0.05). In term of interest to be parents, there
was a significant relationship with ages of the
male participants (P=0.01). Indeed older men
had lower interest to be parent (Table 6,).

Table 6Demographic characteristic and interested to be parents
according to gender

Demographic variable

Gender

Interested to be parents

P value

Marriage age

Male

Krus-kalwalis

0.01*

Female

Krus-kalwalis

0.23

Education

Male

Fishers exact test

0.53

Female

Fishers exact test

0.64

Job

Male

Fishers exact test

0.87

Female

Fishers exact test

0.33

Housing condition

Male

Fishers exact test

0.07

Female

Fishers exact test

0.8

Income

Male

Fishers exact test

0.9

Female

Fishers exact test

0.77

House size

Male

Fishers exact test

0.22

Female

Fishers exact test

0.36

Number of sisters and brothers

Male

Krus-kalwalis

0.28

Female

Fishers exact test

0.04*

*; Significant at P<0.05.

The only factor that contributed to the female
participant’s decision for a desirable number of
siblings was associated with the number of siblings
that they have. In male participants, no association
was observed between the demographic information
and their desire in a number of children.
With an increasing age at marriage and aspiration
for higher educational level, the time interval between
marriage and the birth of the first child has
increased. But this gap has decreased with the increasing
number of siblings. With increasing age
of marriage, education, income and type of residence,
male participants have believed that the age
of marriage of the male gender should be higher.
In female participants, age of marriage, education,
income, and the number of sister(s) or brother (s)
were associated to appropriate age of men for marriage.

The same relationship exists where women considered
a certain age to be suitable for marriage.
With the increase in men’s income, the preference
for bigger houses and higher intervals for pregnancies
have increased but with the increasing number
of siblings both female and male groups stated less
number of intervals between desired pregnancies.
With the increasing age of men at marriage, the desire
to become a father has decreased but this issue
has not been observed in women. With the increasing
number of siblings in women, their desire to
become a mother has increased but this case yield
an opposite results for male participants. There exist
an association among an increasing desire for
parenthood, increasing number of desired children
and also a lesser interval between marriage and the
first conception. For fathers, this desire was associated
with a desire to decrease the interval between
pregnancies.

Discussion

In this study, we presented viewpoints of young
Iranian people and explored related factors. About
50% of the female and male participants have expressed
that the desired number of children for a
desired family is 2 (one girl, one boy). In this study,
the desired number of children per woman from
the perspective of the participants was calculated
to be approximately 1.91 which is below replacement
level. Some sociologists and policy makers
strongly believed that fertility rate is mostly influenced
by the demands and preferences of families
especially women, regarding the desired number
of children. Also the study conducted by Günther
and Harttgen (12) indicated a strong correlation
between the desired number of children and the
actual number of children. The desired number
of children per generation could be affected by the context in which an individual grows (9). Although
some studies have not confirmed this issue,
the actual number of children for a family to the
desired number can be completely different (13).
They believed that between the number of children
expected, and the number of actual children, there
was a slight difference in developed and developing
countries. Developing countries with a high
fertility rate usually expects a lower number of
children, lower than the actual number but in developed
countries the opposite is true. In a study
conducted in Japan, the actual number of children
was 1.77 and the number of desired one has been
reported 2.55 which is significantly lower than the
number of children considered desired (7). The desired
number of children not necessarily will be
concordant with the reality of fertility behavior of
families that named "fertility gap". The reason of
this gap can be due to socio-economic factors such
as divorce, financial problems, higher education,
employment and aspiration for higher income (4).

The number of desired children as expressed by
83.1% of the participants in this study was between
1 to 2. About 20 % favors one child while 63.3%
favors 2 children. On the other hand, despite the
immense interest of the couple to become parents
as observed in this study the desire for less conception
can serve as a warning sign for an increasing
decline of fertility in the country resulting to an
aging population and a reduction of the productive
younger generation. It seems that the overall population
policies must be directed towards more favorable
conditions for economic security and welfare
for the society especially the women’s need
in nurturing her child and transform these policies
to the stage of implementation in order to increase
fertility to a satisfactory condition.

Although in some western countries the desire to
be childless is an ordinary issue, studies have indicated
that European and especially Asian countries
desire to have the number children of that everyone
wants which, is the foundation of living (3, 7).
In Japan, 58.4% of individuals aging 20-29 years
old have expressed that 2 children is desired for a
family, in South Korea 58.7, in the United States
of America 42.2% and in France 56.6% have expressed
2 children as a desired number in a family
(14). Interestingly, there exist a similar tendency in
the desired number of children in most countries
and it seems that there is a convergence of opinions
in this issue in most developed countries and
also in Iran.

In the present study, none of the demographic factors
were related to the men’s choice for a desired
number of children while in women, the increased
number of siblings has been reported to affect the
choice for a desired number. In some studies, the
relationship between age at marriage, education,
income and financial situation justifies childbearing
behavior (8, 13). In fact, motivation to higher
education and higher incomes decreases the motivation
for childbearing (4, 15). The result of this
study about relation between the participants’ age
at marriage and desired number of children was in
line with that of another study in Iran (5).

The results of a study conducted to assess fertility
desire of women in Tehran showed that poor
income was related to fertility disinterest (16).
Although some researchers argued that income
might not purely interpret child birth behaviors
of couples, it is necessary to assess the different
kinds of social support that people receive (10).
One related reason that higher education levels
may lead to less childbearing is balancing between
education affairs and mother roles. Moreover,
more- educated women may attain to a better
career than other women. Also more income and
authority, may provide more control on childbearing
for educated women (17). The possible
reason for the difference in the results of the present
study in comparison to other studies might
be due to the fact that only 12.7% of male participants
have monthly income of 600 US dollars
and approximately 50% have an income of 300$
monthly. In women, these figures have been less.
An important point in this study is that there is
a unanimous agreement among individuals with
different demographic characteristics in the desired
number of children a couple should have.

In this study, advanced age of men and women
during marriage and the pursuit of higher education
has increased the interval between marriage
and the conception of the first child and also the
increased age considered appropriate for marriage
in men and women. With improved income, the
age considered appropriate for marriage in both
genders have also increased. Findings in this study
correspond to the findings of the study conducted
by Ericsson et al. (18) in Sweden which is a qualitative
study on professional men and women postponing conception in favor to acquire higher education.
Participants expressed that the reason for
delayed childbearing in men and women having
higher education is to cope with adapting social
changes and the new life style. Hence; a change
in priorities. Another reason is that nowadays children
are expensive and then parents decide to postpone
their childbearing until they feel they achieve
to more stable economic position. Therefore it is
predictable that most of the couples will have their
first child at later age. Advanced maternal age can
pose a lot of problems in considering the sociocultural
changes in Iran’s present society in which
a little less than half of the female population have
university education. With increasing age of marriage
and time interval between marriage and conception
of the first child, decline in female fertility
will occur (19). Furthermore; advanced maternal
age during pregnancy may be associated with
more medical and obstetrical complications for
mother and fetus that could create a negative effect
on population growth, health and dynamics
respectively (20-22).

Accordingly; as indicated by results of some
studies conducted on Iranian society, there is an increasing
trend between the interval of marriage and
the conception of the first child which can generally
affect the rate of fertility (2). Some studies have
shown that there were misconceptions regarding
fertility in a way that couples presumed that with
the emergence of the modern methods of fertility
treatments, age associated infertility problems will
be completely resolved. Based on the conducted
by Virtala et al. (23) more than 50% of male and
1/3 of female college students have believed that
decline in fertility would only occur at the age of
45 in women. Also, in another study conducted on
non-medical students, they believed that women’s
fertility can still be preserved even with increasing
age. Therefore, they can plan to have their pregnancy
at ages when fertility declines (24).

Community policy-makers must be aware of
this issue and should address significant issues in
their policies regarding childbearing to support
families. Some studies have shown that policies
designed and implemented to resolve conflict between
work and study have played an important
role in strengthening the couples desire for childbearing
and helping couples to counter their decision
for postponement of conception on their first
child (4). Although the availability of contraceptive
methods is considered to be one of the factors
affecting reproductive behavior, the most important
factor in order to achieve success in changing
the community’s behavior towards fertility is more
understanding in order to reduce conflicts between
maternal and paternal roles, education and employment
(4).

In this study, having more siblings was related to
higher number of desired children in women, the
shorter first birth intervals, and pregnancy intervals
in men and women. One key point in this regard
is the effect that someone may receive from his
family background variables. It may be related to
common values of individuals in a family. Several
studies have emphasized the essential role of social
interaction for fertility behaviors (4, 25). The
present study has several strengths. It was a part of
the first national study about fertility preferences
and desired numbers of children. The mentioned
topic that has also not been studied among the general
population in Iran. Convenience sampling was
a limitation of our study. The sample was a part of
the large study that has been conducted by MOH
of Iran. The response rate was very good and neat
to all of the couples answered to the questionnaire,
therefore the study results reflect their opinions
reliably. Further studies with a larger number of
samples, or nationally representative studies are
suggested to achieve to more precise findings. In
addition, future studies are proposed to assess attitude
of couples about fertility and their fertility
awareness to obtain more interpretable findings.

Conclusion

In this study, preferences and desires related
to the reproductive behavior on couple’s prior to
marriage were evaluated and one of the strong
points that can be pointed out is that, these couples
will serve as representatives for the whole
province for the reason that all couples would refer
to these 2 clinics for pre-marriage counseling.
Majority of the participants of the present study
express their desire to have one or two siblings.
In considering the fact that what one desires does
not always come into reality, the risk of reduced
fertility is generally present in the community
and in order to create a favorable environment
for childbearing, appropriate policies should be
implemented.

Acknowledgements

The authors express their thanks to the individuals
who willingly participated in this study. Financial
support was carried out by Iran’s Ministry of
Health. The authors declare no conflict of interest.

Shiri T,
Bidarian S.
Economic factors affecting the fertility of women 15-49 years old population employed in the school districs 22 of Tehran.
Journal of Social Sciences.
2009;
3(3):
93-107.

6

Ding QJ,
Hesketh T.
Family size, fertility preferences, and sex ratio in China in the era of the one child family policy: results from national family planning and reproductive health survey.
BMJ.
2006;
333(7564):
371-373.

Morita M,
Ohtsuki H,
Sasaki A,
Hiraiwa-Hasegawa M.
Factors affecting the number of children in five developed countries: a statistical analysis with an evolutionary perspective.
Letters on Evolutionary Behavioral Science.
2012;
3(1):
7-11.